an unhealthy start in life what matters most

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Editorial An Unhealthy Start in Life— What Matters Most? Colleen F. Moore University of Wisconsin Life isn’t fair. The following monograph describes how neurotoxic metals, micro nutrient defici encies, and socia l environ- ments can combine to give a child an unhealthy start in life. Visualize a preschool child from a low-income family in the United States, growing up in a poorly maintained older apart- ment with peeling paint and windowsills laden with lead dust. Perhaps this child also attends a day-care center with a high chi ld- to- car eta ker rat io tha t pre vents the car eta ker s fro m spe ndi ng muc h time int era cti ng wit h thechildren, andwhere the children often squabble over the toys that are present. Because of the high child-to-caretake r ratio, the caretakers are rel atively harsh in their discipline. The child’s parents both work, but at low-wage part-time jobs without health insurance or sick leave. The family’s food stamps run out each month, and only one visit to the fo od pa nt ry per mont h is al lo wed. The chil d ha s no pi ct ure boo ks and few age -ap pro pri ate toy s bec ause the family has changed re si dence thre e ti mes in the past2 ye ars. Unabl e to pay the rent, they lived in a homeless shelter once while between residences, with no place to store their personal belongings. The scenario I have described above is real life for too many American children. We know that a child growing up with poor nutrition, lead or other toxic exposures, low-quality day care, and li tt le st imul at ion in the home is getting anunfa ir st ar t in li fe. But which of the factors in this child’s life are the most influ- ential? Perhaps that question is too simple: The problem is that ris k fac tor s often occ ur in an interc orr ela ted comple x tha t cannot be untangled easily by statistical control. This monograph, by the interdisciplinary team of Hubbs-Tait, Nations, Krebs, and Bellinger, invites us to think more deeply about how the effects of metallic neurotoxicants, deficiency in micronu- trients, and aspects of the social environment can, separately and together, influence children’s behavioral health. The effects of combinations of risk factors on children’s development have lon g been a puz zle to dev elo pme ntal res ear che rs. One sol uti on is to say , ‘‘Risk fac tor s add up, so more risks are wor se—reg ard les s of the type of risk.’’ Certainly there is truth in that answer, but this monograph sets the stage for new inquiries, with the po- ten tia l to ide nti fy bot h pro tec tiv e fac tor s as wel l as combin ati ons of events that potentiate each other’s negative effects. For example, does iron deficiency make lead exposure more delete- riou s to a child ’s cognitive functioni ng? Alter native ly , does treatment of iron or zinc deficiency imply that lead will have weaker effects on a child’s cognition or behavior? The authors make the case that the effects of all three cate- gories of influence may be subject to ‘‘effect modifiers,’’ or interactions that exacerbate (or ameliorate) their influence. If we are to identify and establish preventative programs for children who are most susceptible to toxic exposures, micronutrient defici enc y , and poo r soc ial env iro nments, the n we nee d to con sider interactions. The authors also point out that unless all three sources of influence are considered, we could incorrectly at- tri bute str ong er or wea ker infl uen ce to any one ind ivi dual fac tor . For example, in epidemiological studies of the effects of neurotoxicants such as lead and mercury, investigators partial out the effects of social variables such as income, social quality of the home, par ent al edu cat ion, and rac ial or eth nic ide nti ty of the pa rent s or chil d. But itisra therunusua l for st udies of the impact of social influences such as parental sensitivity, parental edu- cation, or socioeconomic status to statistically control for either neurotoxic exposures or nutritional status in the child. Because of these standard research practices, estimates of the effects of social factors are likely overestimated, as are the effects of mi- cronutrients. The report is also cutting edge in the way it combines animal research on the mechanisms by which toxic metals, micronu- trients, and environmental stimulation affect neural function and development with epidemiological research on children’s cognitive and behavioral outcomes. Some of the latest work on neurotransmitter systems and their complex interactions is re- flected here. For example, manganese is both a micronutrient and, at higher exposures, a neurotoxicant. Manganese affects glutamate uptake in certain areas of the brain, but it also affects dopaminergic systems. Lead can also alter glutamate neurotransmitter systems that are known to be involved in learning. These kinds of findings help us understand why lead and manganese are neurotoxic and what behavioral effects to look for. But such findings also raise the issues of coexposure to toxic subst ances and how micronutri ents combi ne with neurotoxi - cants. The report calls for research that will address exposure to manga nese and cadmi um becau se these neurotox icant s are PSYCHOLOGICAL SCIENCE IN THE PUBLIC INTEREST V olume 6—Number 3 i Copyright r 2005 American Psychological Society

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